Dizziness is a general term encompassing specific symptoms which include pre-syncope, disequilibrium and vertigo. Pre-syncope is also known as lightheadedness. It is often described as a sensation of fainting spell which is usually cardiovascular in etiology. Pre-syncope is associated with orthostatic hypotension and not with a primary central nervous system problem. Orthostatic hypotension is a significant fall in blood pressure during rapid changes in position such as shifting from a supine or seated position to a standing position. An orthostatic hypotension manifested as lightheadedness with accompanying loss of consciousness is now termed as syncope. Syncope results from a temporary disturbance in cerebral blood flow.

Dizziness

The second form of dizziness known in the medical field is vertigo. Vertigo is defined as a severe spinning or whirling sensation. The pathology of vertigo lies either in the brain particularly at the cerebellum (the part of the brain responsible for balance, smooth coordinated voluntary muscle movement) or at the inner ear where the semicircular canals and the rest of the vestibular apparatus for maintenance of balance are located. Any problem at the cerebellar area (e.g. cerebellar infarct or cerebellar hemorrhage) or at the inner ear (e.g. acoustic neuroma also known as vestibular schwannoma, labyrinthitis, otitis interna, Meniere’s disease, bening paroxysmal positional vertigo or BPPV) may lead to an impairment in equilibrium hence; dizziness is felt by the patient. One of the abovementioned otologic causes of dizziness which is Meniere’s disease is characterized by a triad of symptoms namely: tinnitus or ringing of the ears, hearing loss and vertigo. Symptoms of vertigo may be severe leading to impairment in walking and standing, a balance problem that may greatly affect the activities of daily living of the patient.

Other central nervous system (CNS) pathology include the following : arteria basilaris syndrome, posterior fossa neoplasm or tumor, cerebral concussion, migraine headaches with or without aura, multiple sclerosis, cerebrovascular accident (CVA) or stroke (also known as “brain attack”), and peripheral neuropathy. Although a vertigo due to affected balance centers of the brain is typically milder than other causes, CNS causes are accompanied usually by other focal neurologic deficits such as diplopia (double vision) or slurred speech.

Other causes of dizziness are: breathing impairment such as hyperpnea or hyperventilation like in hysterical and emotionally induced-fainting situations, excessive intake of helium, AIDS, hypoglycemia due to impaired eating habits in conditions such as anorexia nervosa and bulimia nervosa, and low blood pressure in circulatory collapse or shock (e.g. acute hemorrhagic blood loss or chronic blood loss like anemia due to chronic illness or cancer).

Motion sickness may also manifest as vertigo accompanied by nausea and vomiting. Other etiologic causes of dizziness include: eye problems particularly error of refraction such as astigmatism, hyperopia (far-sightedness) , myopia (near-sightedness), new glasses or lenses and neck problems such as cervical arthritis, whiplash (cervical) injury and other strains like cervical spondylitis.

Do not disregard any dizzy spell unless life threatening causes of dizziness has been ruled out such as cerebellopontine angle (CPA) mass or tumor. Some serious life threatening illness may start only with dizziness. Hence, presence of any new symptoms for the first time or worsening of dizziness without any obvious cause may be detrimental to your health if you do not seek medical help.

Imaging studies like the brain CT scans and magnetic resonance imaging (MRI) are the most routine laboratory diagnostic aids used in the evaluation of patients with dizziness. Moreover, the diagnosis of dizziness is basically made from the clinical presentation of the dizzy spells as relayed by the patient and a complete physical examination, focusing on the ears and central nervous system findings. Some tests performed to ensure that hearing and balance is intact include the Rinne and Weber hearing tests and the Romberg test respectively. These tests are performed by otorhinolaryngologists. Rarely, electrical recordings of the brain (electroencephalogram or EEG) may be required to make confirm the initial impression and rule out any other alternative diagnoses.

A preventive measure that you can do at home to prevent particularly orthostatic cause of dizziness is to be careful when changing positions (e.g. lying to standing position). You can stand up more slowly when you want to change positions. Adequate water intake, regular meals and rest may also help prevent dizziness.

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